The Specialist in Emergency-Urgency Medicine must have gained theoretical, scientific and professional knowledge in the fields of the first diagnostic framework (both intra and extra-hospital) and the first treatment of medical, surgical and traumatological emergencies; therefore, the specialist in Emergency-Urgency Medicine must have gained professional and scientific skills in the field of pathophysiology, clinical and therapy of medical emergencies and emergencies, as well as epidemiology and management of territorial emergencies in order to be able to operate with full autonomy, in compliance with ethical principles, in the integrated system of Emergency-Urgency.

Basic educational objectives: the Resident must deepen and update his/her knowledge on the biological and genetic bases of diseases, on the pathophysiological correlations between the functional alteration of the various organs and systems and clinical syndromes with particular reference to the clinical conditions of emergency-urgency and on the knowledge of pharmacological and/or instrumental treatment protocols for emergencies-urgencies.

Objectives of the general training: the student must acquire knowledge (epidemiological, clinical, psychological and ethical) and the methodology for a global and unitary approach to the solution of complex health problems; the development of clinical reasoning oriented towards analysis "by problems" and their solution; the knowledge of the short-term prognosis of the various pathologies and clinical syndromes; the maturation of critical and analytical diagnostic skills (diagnosis by positive, etiological and differential elements), setting up and personally verifying the diagnostic process; full knowledge of the main diagnostic procedures and laboratory and instrumental investigations; the deepening of knowledge relating to drugs both for pharmacological characteristics and for indications, contraindications, interactions and iatrogenic accidents; the maturation of the critical capacity necessary for the application, in the individual case, of the results of scientific research; the ability to apply the methodology of clinical, experimental and therapeutic research; knowledge of the correct use of resources and budget and quality monitoring.

Educational objectives of the type of School: the Resident must achieve full autonomy in order to operate in the integrated system of emergencies-urgencies. In particular: it must be able to participate in and manage out-of-hospital rescue and to integrate the information of pre-hospital interventions for rapid in-hospital classification and treatment; must be able to frame, resuscitate, stabilize and treat any patient with critical issues who present themselves to local or hospital structures, also defining the most suitable hospital or the most suitable path for the treatment of the patient; must be able to establish the priorities of intervention for several patients, with different clinical pictures, who have arrived at the same time in the Emergency-Acceptance Department in order to optimize treatment; must know how to treat and manage the airways; must be able to assess the need for a possible more appropriate transfer, i.e. plan a correct "action plan" and/or follow-up; it must be able to provide the patient with the health education necessary for the prevention of diseases and traumas; must know how to correctly use the diagnostic and therapeutic resources available in the different operational realities; must learn the principles for the treatment of paediatric, geriatric and pregnant patients; must know the techniques for communicating effectively with patients, family members and other professionals involved in patient management; must possess the technical and organisational knowledge for the management of disaster-related emergencies; They must learn the ethical principles involved in medical decision-making, including guidelines for continuation and life-sustaining treatment. The resident must also know the legal and health organization aspects of the profession, as well as those of the NHS, with particular reference to the regulations relating to the integrated emergency-urgency system.

Specific areas of competence of the specialist in Emergency Medicine are: the assessment of the degree of urgency and/or care priorities in relation to all interfering clinical-environmental factors; the evaluation of vital functions and maneuvers and therapies for emergency cardiopulmonary resuscitation and for patient stabilization; the pathophysiology, functional and instrumental semeiotics, clinical methodology, diagnosis and emergency therapy (pharmacological and instrumental) of any pathology that presents with emergency-emergence characteristics; epidemiology and management, as far as it is concerned, of territorial emergencies, including disasters; knowledge and application of management principles in order to optimise resources and quality standards; etiopathogenesics, epidemiological and clinical-therapeutic research applied to emergencies-urgencies; accident prevention and health promotion.

Integrated training objectives (i.e. common trunk): the student must have acquired satisfactory theoretical knowledge and professional competence in the clinical and instrumental diagnosis and treatment, even in emergency-urgency conditions, of the most common internal pathologies. The student must acquire the fundamental knowledge of the pathophysiology of the various organs and systems, the theoretical and practical knowledge necessary for the recognition of diseases affecting the different systems of the body, the theoretical and practical knowledge of the main sectors of instrumental and laboratory diagnostics related to the aforementioned diseases, the acquisition of the ability to evaluate internal and specialist connections and influences. He must therefore be able to recognize the symptoms and clinical-functional signs with which diseases of various organs and systems manifest themselves, having acquired the fundamental diagnostic, therapeutic, psychological and ethical knowledge necessary for a global vision of the patient. To this end, the ability to clinically frame the patient on the basis of the anamnesis and physical examination must mature; develop critical and analytical diagnostic skills; become familiar with the main diagnostic procedures and laboratory-instrumental investigations; recognise and be able to deal with major medical emergencies; familiarize themselves with therapeutic resources in order to plan their optimal use and recognize their indications and contraindications, as well as the effects of interaction and possible iatrogenic accidents; acquire the fundamental notions relating to clinical research methodologies and pharmacological trials; know the fundamental problems related to prevention, public health and social medicine. The resident must have acquired satisfactory theoretical knowledge and professional competence in the recognition and treatment, in emergency-urgency conditions, of the most common pathologies. Finally, the resident must also know, from a clinical and therapeutic point of view, the most common pathologies of competence of the other types of the class.

The following are compulsory professionalizing activities for the achievement of the educational purposes of the Emergency-Urgency Medicine typology:

• have participated, for at least 3 years, in medical activity - including day, night and holiday on-call shifts - in the Emergency-Acceptance facilities - and in the related facilities - identified as part of the training network;
• have drawn up and signed at least 300 medical records of patients in the Emergency-Acceptance facilities and in related facilities;
• have actively participated in the management of at least 50 major traumatized patients and know how to manage the "Trauma Team";
• have spent at least 3 weeks a year for at least 3 years in territorial emergency shifts;
• know how to implement electrocardiographic monitoring, non-bloody and bloody blood pressure, central venous pressure, arterial oxygen saturation;
• have performed at least 10 airway unobstructions, 30 Ambu balloon ventilations, 20 emergency oro-tracheal intubations (*);
• know how to practice emergency surgical access to the airways: cricothyroidotomy (*);
• know how to perform invasive and non-invasive mechanical ventilation manually and with pressometric and volumetric ventilators (*);
• know how to administer the various modes of oxygen therapy;
• have placed at least 20 central venous catheters (internal jugular, subclavian and femoral) (*);
• have placed at least 10 intraosseous accesses(*);
• have placed at least 10 arterial needle cannulas (radial and femoral) (*);
• have interpreted at least 100 arterial blood gas analyses, with arterial sampling personally performed (*);
• have practiced at least 5 direct and ultrasound-guided thoracentesis, with placement of needles and thoracostomic tubes (*);
• have placed at least 20 nasocratic tubes, including placement in the comatose patient(*);
• know how to perform pericardiocentesis(*);
• have interpreted at least 50 chest X-rays, 20 direct X-rays of the abdomen, 50 bone X-rays, 20 CT scans (skull, cervical, thoracic, abdominal) and 10 MRI of the skull;
• have practiced and interpreted at least 40 ultrasound examinations for cardiac, thoracic and abdominal emergencies (*);
• have practiced and interpreted at least 30 venous and arterial Doppler ultrasounds (*);
• have performed and interpreted at least 200 ECGs;
• have performed at least 20 cardioversions (*) and 20 electrical defibrillations (*);
• have practiced at least 20 external cardiac massages with the application of resuscitation maneuvers (*);
• have placed at least 10 external pacemakers and know how to place transvenous pacemakers (*);
• have practiced at least 10 sedation-analgesias per procedure;
• have practiced at least 20 local anesthesias;
• have disinfected and sutured at least 40 superficial wounds
• know how to make bandages, splints and casts for immobilization of bone fractures (*);
• have practiced at least 5 immobilizations for the prophylaxis of spinal cord injuries and pelvic fractures (*);
• know how to perform dislocation reduction (*);
• know how to perform lumbar punctures(*);
• have actively participated in the management of at least 20 strokes in the acute phase (*);
• have practiced at least 20 bladder catheterizations (Foley catheter, suprapubic) (*);
• have examined at least 10 patients with eye emergencies;
• have practiced and interpreted at least 10 otoscopies(*);
• have practiced at least 5 anterior and posterior rear-end rear-end collisions to control epistaxis(*);
• have actively participated in at least 10 births(*);
• know how to perform decontamination procedures (cutaneous and gastric including the placement of nasogastric tubes to perform gastric and intestinal lavage) (*);
• have participated directly in the management and decision-making processes of the 118 operations center.

The learning of the professionalizing activities indicated with (*) can take place through simulation for a maximum percentage of 30%

The student will be able to compete for the diploma after completing the professionalizing activities.

As part of the training course, the student will have to learn the scientific bases of the type of School in order to achieve full maturity and professional competence that includes an adequate ability to interpret scientific innovations and critical knowledge that allows him to consciously manage both assistance and his own updating; In this context, participation in meetings, congresses and the production of scientific publications and periods of attendance in qualified Italian and foreign institutions useful for his/her training may be envisaged